DIAGNOSTIC LAPAROSCOPY AS AN ADJUNCT TO SELECTIVE CONSERVATIVE MANAGEMENT OF SOLID ORGAN INJURIES AFTER BLUNT ABDOMINAL TRAUMA

1993 ◽  
Vol 35 (4) ◽  
pp. 647-653 ◽  
Author(s):  
Michael C. Townsend ◽  
Louis Flancbaum ◽  
Patricia S. Choban ◽  
Charles T. Cloutier
Keyword(s):  
Abdominal Trauma ◽  
Conservative Management ◽  
Blunt Abdominal Trauma ◽  
Diagnostic Laparoscopy ◽  
Solid Organ

scholarly journals Isolated gallbladder perforation in paediatric blunt abdominal injury: A case report and review of literature

2021 ◽  
Vol 7 (2) ◽  
pp. 103-107
Author(s):  
Sujoy Neogi ◽  
Arka Banerjee ◽  
Shasanka S Panda ◽  
Simmi K Ratan
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Diagnostic Laparoscopy ◽  
Road Accident ◽  
Organ Injury ◽  
Current Evidence ◽  
Gallbladder Perforation ◽  
Free Fluid ◽  
Solid Organ ◽  
Blunt Abdominal Injury

Gallbladder injury in blunt abdominal trauma is rare, around 2% of all abdominal traumas. Vague symptoms and inconclusive imaging make it an elusive diagnosis, more so in children. Only 30 pediatric cases have been reported worldwide till date. We report a case of a 7yrs old boy presenting 2 weeks after a road accident with a gallbladder rupture which was eventually discovered on a diagnostic laparoscopy. This is the second such case being reported from India. The injury is most often identified at exploration and although cholecystectomy is the preferred treatment, there are occasions when the gallbladder may be left in situ. The classification system of Losanoff and Kjossev has merit in guiding treatment. The various presentations, mechanisms and modes of injury have been highlighted along with the clinical and imaging findings. Despite the developments in modern radiology, identifying gallbladder perforation has always been difficult because of the rarity of the condition. In a child with blunt abdominal trauma and intra-abdominal free fluid without any solid organ injury, a diagnostic peritoneal tap may be helpful. Based on the current evidence, we advocate a low threshold for performing a diagnostic laparoscopy in all such cases.

scholarly journals A prospective and retrospective study on conservative management of hepatic and splenic injury following blunt abdominal trauma

2020 ◽  
Vol 7 (6) ◽  
pp. 1930
Author(s):  
Induchoodan Ponnamma Pillai Sukumaran Nair ◽  
Rajesh P. S.
Keyword(s):  
Abdominal Trauma ◽  
Conservative Management ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Road Traffic ◽  
Operative Management ◽  
Splenic Trauma ◽  
Solid Organ ◽  
Non Operative Management

Background: worldwide road traffic accidents accounts as the leading cause of death of young people. For a very long time most of the intra-abdominal injuries following blunt abdominal trauma were managed operatively. Conservative management is becoming more acceptable and effective management option for blunt abdominal trauma during the last few decades.Methods: This study was conducted in Government Medical College, Kottayam during September 2007 to December 2008. All conservatively managed blunt abdominal trauma patients during the study period were included in the study.Results: Out of 22 patients, 4 patients failed conservative management. Success rate was 81%. Most commonly injured solid organ in the study group was liver (77%). Maximum cases were of age group 10 to 20 (31.81%) years. 81% of patients were males. Motor vehicle accident was the most common cause of trauma (77%). Mean stay in intensive care unit was 4.2 days and mean hospital stay was 15.7 days. Mean systolic blood pressure was 110 mmHg ranging from 70 to 130 mmHg. 50% of patients had moderate hemoperitoneum and non-had massive hemoperitoneum.Conclusions: Non operative management is safe and effective approach in blunt spleen and liver injuries. Non operative management should be treatment of choice for all hemodynamically stable patients with blunt liver and splenic trauma.

Is Hypaque Dangerous?

PEDIATRICS ◽  
1989 ◽  
Vol 83 (4) ◽  
pp. 650-650
Author(s):  
ROBERT SCHLECHTER ◽  
ABRAHAM BESSERMAN
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Ct Scanning ◽  
Ct Scans ◽  
Solid Organ ◽  
Abdominal Ct ◽  
Injured Child ◽  
Gastric Distention ◽  
Close Observation

Concerning the use of diatrizoate sodium (Hypaque) in abdominal CT scans described by Kane et al (Pediatrics 1988;82:11-15), we agree that there is certainly much to be gained from CT scanning in blunt abdominal trauma. We question the routine use of diatrizoate sodium in an injured child predisposed to gastric distention and vomiting. This is particularly dangerous when he or she is prone and restrained and close observation at the bedside is not possible. Solid organ injuries are well demonstrated without contrast, and injury to a viscus can be evaluated clinically and by routine roentgenographic procedures.

Isolated Low-Grade Solid Organ Injuries in Children Following Blunt Abdominal Trauma

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Leah Plumblee ◽  
Regan Williams ◽  
Dennis Vane ◽  
Jingwen Zhang ◽  
Aaron Jensen ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Low Grade ◽  
Solid Organ

Intra-abdominal Free Fluid without Solid Organ Injury in Blunt Abdominal Trauma: An Indication for Laparotomy

2002 ◽  
Vol 52 (6) ◽  
pp. 1134-1140 ◽  
Author(s):  
Alexander K. T. Ng ◽  
Richard K. Simons ◽  
William C. Torreggiani ◽  
Stephen G. F. Ho ◽  
Andrew W. Kirkpatrick ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Organ Injury ◽  
Free Fluid ◽  
Solid Organ ◽  
Solid Organ Injury

scholarly journals Challenges in management of blunt abdominal trauma: a prospective study

2018 ◽  
Vol 5 (10) ◽  
pp. 3298
Author(s):  
Rajkumar P. N. ◽  
Kushal Kumar T. R. ◽  
Deepak G.
Keyword(s):  
Prospective Study ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Imaging Modality ◽  
Tertiary Care ◽  
Organ Injury ◽  
Solid Organ ◽  
Vehicle Accident

Background: Trauma meets the pandemic criteria, with a daily worldwide mortality as high as 16000. Abdominal trauma remains a leading cause of mortality in all age groups. Blunt abdominal trauma (BAT) mainly results from motor vehicle accident, fall from height and assaults. The commonest organ injured is the spleen, followed by the liver and small bowel. Lately, the management of BAT has changed from operative to non-operative management. This study was done to analyse the incidence, patterns, current management practiced, and challenges encountered in BAT treated operatively.Methods: This Prospective study was conducted in tertiary care centre in Bangalore during August 2015 to December 2017. 475 patients with blunt abdominal injuries who reported to emergency department were selected for the study based on following inclusion and exclusion criteria.Results: A total of 475 cases of BAT were assessed with a mean age of males and females was 32.6 and 28.3year respectively. Most patients (65%) were between 21 to 30 years of life. Most common mode of injury was motor vehicle accident (57.68%), 60% patients presented to hospital within the initial 4 hours. Abdominal CT had highest accuracy. Most common solid organ injury being spleen (26.5%). 80.84% patients were selected for SNOM and 15.62% had Failed SNOM. 28.48% patients had complications with most common complication wound infection followed by aspiration pneumonia and 7 patients had mortality.Conclusions: Initial resuscitation with thorough clinical examination with correct usage of imaging modalities with timely and proper decision making is the key of management of patients with BAT and there is a need to identify newer imaging modality/procedure which helps to determine better management scheme in all blunt trauma patients. 

scholarly journals Lactate clearance: its relationship with the success of non-operative management in patient with blunt abdominal trauma

2017 ◽  
Vol 4 (5) ◽  
pp. 1738
Author(s):  
Reno Rudiman ◽  
Nova Saragih ◽  
Andriana Purnama
Keyword(s):  
Hemorrhagic Shock ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Operative Management ◽  
Lactate Clearance ◽  
Trauma Patients ◽  
Solid Organ ◽  
Chi Square ◽  
History Of ◽  
Non Operative Management

Background: Occult ongoing bleeding has become the second highest cause of death in blunt abdominal trauma. Undetected abdominal injury has caused morbidity and mortality in patients at the early phases of trauma. Non-operative Management (NOM) in solid organ trauma is safe and effective, and this strategy has become widely used. Lactate clearance (LC) has important clinical benefits in patients with acute trauma that is superior to initial lactate examination.  Methods: This study was a prospective cohort study of patients with history of hemorrhagic shock caused by blunt abdominal trauma that came to emergency room of Hasan Sadikin Hospital Bandung from August 2015 to July 2016. The tests were including initial blood lactate, 2 hours, and 4 hours post-resuscitation and then calculation of LC. Analysis using SPSS with chi square for the significance of relationships and Spearman correlation to determine the strength of the relationship between variables. Comparison test between LC2 and LC4 were calculated using Mann-Whitney tests.Results: During one year period, from August 2015 to July 2016, there were 34 patients. Age was in the range of 15-65 years, with a range of 15-25 years were 19 (55.8%), 25-50 years were 11 (32.4%), and >50 years as many as four (11.8%). By sex, there were 28 (82.4%) male gender and 6 (17.6%) women. Based on the type of trauma, there were 11 (32.4%) single trauma patients and 23 (67.6%) multiple trauma patients. Based on the results of statistical analysis with chi square, there was a significant correlation between lactate clearance 2 hours (LC2) and lactate clearance 4 hours (LC4) with the success of NOM (p <0.001) with the Odds Ratio (OR) are 3.750 and 6.500 respectively. Based on non-parametric test (Mann Whitney) showed that there were no significant differences between the LC2 and LC4 in determining the successful of NOM (p>0.05).Conclusions: There was a significant relationship between lactate clearance 2 hours (LC2) and lactate clearance 4 hours (LC4) in determining the success of non-operative management (NOM) in patients with history of hemorrhagic shock caused by blunt abdominal trauma. In addition, there are no significant differences between the LC2 and LC4 in determining the success of the NOM, so that either LC2 or LC4 may be used in predicting the success of NOM, as LC4 is the first preference. The low level of lactate clearance may be used as one of indicators to terminate non-operative management and proceed with surgery right before all symptoms of hemorrhagic shock arise.

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